术前介入在肝母细胞瘤治疗中的应用评价

Appraisal of preoperative interventional therapy in the treatment of hepatoblastoma in infants

目的 探讨介入治疗在小儿肝母细胞瘤综合治疗中的地位及适应证。方法 对估计不能切除的肿瘤施以碘油化疗药物栓塞 ,然后再外科手术 ,9例中有 7例施行了肝叶切除 ,右三叶 3例 ,右半肝 2例 ,左半肝 2例。结果 介入后 ,小儿副反应轻 ,肿瘤体积缩小 ,6例AFP值下降。未施手术1例介入后肺转移死亡 ,探查术 1例后改肝移植术后死亡 ,肝叶切除 7例中 ,死亡 5例 ( 3例复发 ,1例脑转移 ,1例肝功能衰竭 )存活 2例健在。结论 介入治疗可以使某些不能Ⅰ期切除的肝母细胞瘤有了手术切除的机会 。

Objective To discuss the indications and role of the preoperative interventional therapy for hepatoblastoma in infants.Methods Transcatheter oily chemoembolization (TOCA) was first used in infantile hepatoblastoma that might be unresectable before operation. Seven out of 9 received hepatectomy (three right lobes lobectomy in 3,right half hepatectomy and left half hepatectomy in 2 respectively).Results After interventional therapy,the size of tumor was decreased and the level of APF reduced.One patients died of lung metastasis after interventional therapy. Another 1 died after liver transplantation. Among 7 patients who received hepatectomy,5 died ( recurrence 3,brain metastasis 1,liver function failure 1) and 2 survived.Conclusion With appropriate indication and manipulation,the preoperative interventional therapy may increase the surgical removal of some unresectable hepatoblastoma in infants.